Commentary

Quick fixes won’t produce long-term results for kids. Here’s a plan for Oregon.

The crisis in children’s behavioral health in Oregon will take focused work by state, nonprofits and legislators

November 15, 2021 5:30 am

Oregon families and service providers need reforms on state’s system for paying for care. (Getty Images)

The Oregon Alliance is a century-old association whose members provide direct care to children, youth, and families in a variety of mental health and addiction treatment settings, including outpatient, therapeutic residential, and in the home and community.

Alliance members sit in a unique crossroad where many services, government systems, and people enter a child and family’s life.

Before the pandemic, our state partners, advocates, and providers recognized Oregon’s mental health and substance use treatment systems for children and youth was and is in crisis and fundamentally failing to serve children, youth, and families, especially those who have complex needs.

Tragically, this crisis is not a complete surprise, given the historical lack of investment over the years. In 2020, Oregon had the highest rate of youth mental health illness and was only 47th in access to care.

Then Covid hit, resulting in more children and youth being isolated at home, disrupting their education, or turning to substance use to ease anxiety. This, along with severe staffing shortages, compelled the Oregon Legislature and state agencies to divert one-time resources to providers to raise wages, provide childcare for staff, and help them to stay in their jobs. We truly appreciate these efforts.

Parents are left on their own, becoming more frustrated and stressed, which only exacerbates their child in crisis.

– Royce Bowlin

But limited one-time funding isn’t going to fix a broken system. We need long-term solutions:

•Mental health and substance use reimbursement rates to providers that are comparable to the private sector.

Today, most reimbursement rates don’t pay the real cost of providing mental health services. As a result, community-based providers are forced to fundraise in their community, use reserves, or move resources from one program to another.

Instead, the rate must include a competitive salary and benefits for staff, resources that support an organizational infrastructure to monitor and improve quality of services, provide professional development opportunities and training to staff and their supervisors, and ensure the effectiveness of services being provided.

• A fundamental shift in how services are paid, moving away from a traditional fee-for-service system that pays for volume of services to alternative payment models that reward high-quality, cost-effective care and takes into account the impact of community trauma and the social determinants of health

•Pay for capacity in high end and crisis services. Firefighters, for example, are funded in a way that allows them to always be ready (have capacity) to respond to a fire or medical emergency when it is needed, not just when there is an existing emergency.

This should be the same for children and family mental health and substance use services. If there’s no capacity, the child doesn’t somehow get better. Instead, they wait and get worse. Parents are left on their own, becoming more frustrated and stressed, which only exacerbates their child in crisis.

•Promote and develop a culturally and linguistically responsive continuum of care.

•Support the increase of additional career development pipelines in the mental health and substance use field to bring in more individuals with lived experience, who are critical to successfully treating children in crisis, and represent the diversity of the community being served.

•Reopen recently closed facilities or those who have closed intake.

•Fund more prevention efforts, keep children, youth, and their families together whenever possible.

Incentivize partnerships and collaborations that focus on the integration of physical and mental health services that lead to strengthening the sector’s capacity to treat whole persons, whole families and whole communities.

This may seem like a daunting list but if we work together – families, payers, providers, employers, and governmental entities – we can all positively and cost-effectively influence mental health and substance use outcomes by engaging individuals and communities, and intervening early to prevent trauma and harm to children.

The alternative is failing children and families.

This will lead to higher costs to the state and our communities, increased rate of youth and adult homelessness, and long-term health and economic challenges for youth who do not receive services.

Together, we can bend the arc towards prevention which is critical to mitigate the significant rise in behavioral health needs as a result of the stress, anxiety, and social isolation caused by the pandemic.

We know families will be stronger and successful when everyone works for what’s best for children and youth.

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Royce Bowlin

Royce Bowlin is the executive director of the Oregon Alliance and was behavioral health director for the Oregon Health Authority from 2016 to 2018.

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